Reducing The Rate of Inappropriate Inpatient Transthoracic Echocardiograms Through an Educational Intervention

Abstract

Introduction Transthoracic echocardiogram (TTE) is a popular imaging modality frequently ordered in the inpatient setting for diagnosis and management of cardiovascular diseases. However, TTEs are a limited resource, and inappropriate use contributes to unnecessary cost and delays in patient care. Our aim was to decrease the burden of inappropriate inpatient TTEs by 50% over 6 weeks through an educational intervention at an academic medical center. Methods We developed and implemented an educational intervention in January 2020 at a large tertiary care academic medical center by delivering lectures to Internal Medicine residents during daily conferences about the 2011 appropriate use criteria (AUC) for TTEs according to the American College of Cardiology. We chart reviewed all TTEs ordered for patients admitted to the general medicine service in the 6 weeks preceding and 6 weeks following our educational intervention. TTEs ordered by the cardiology team or CCU were excluded. We analyzed the proportion of appropriate TTEs ordered based on the AUC and total time to completion over these two periods. Results The median proportion of appropriately ordered TTEs over the duration of the study was 88.3% (Figure 1). In the pre-intervention period, the median proportion of appropriately ordered TTEs was 95.5% with an average time to completion of 23.6 hours. In the post-intervention period, the median proportion of appropriately ordered TTEs was 85.7% with an average time to completion of 29.2 hours. Conclusion The TTEs ordered by internal medicine residents are largely appropriate even before being educated on AUC. The proportion of appropriate TTEs decreased slightly in the post-intervention period, which may be related to normal variation or a by-product of the continual rotation of trainees and need for a longer study duration. Future efforts to achieve a higher rate of appropriately ordered TTEs will include providing this education on AUC to other non-medicine services and implementing a TTE order set containing the AUC.